Modern Dental, Inc

Primary specialty

DentistTaxonomy code 122300000X

License

008680 Issued in CT

Legal business name

MODERN DENTAL, INC

Practice address

740 N Main St
West Hartford, CT 06117-2480

Phone

(860) 232-3866

Fax

(860) 232-3621

NPI assigned

Aug 26, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elaine M Babineau

Title

Office Manager

Phone

(860) 395-5200

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251244800000",
    "number": "1609009588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 N MAIN ST",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061172480",
            "telephone_number": "860-232-3866",
            "fax_number": "860-232-3621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 N MAIN ST",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061172480",
            "telephone_number": "860-232-3866",
            "fax_number": "860-232-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-26",
        "last_updated": "2009-08-26",
        "status": "A",
        "authorized_official_last_name": "BABINEAU",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "860-395-5200"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CT",
            "license": "008680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.